The health challenges of the coming decades may look significantly different to those faced today. Demographic changes, technological advances, and socioeconomic and environmental developments, to name a few, are expected to shape—and in some cases transform—the future health and social care landscape.
This article presents findings from a survey conducted by RAND Europe at the request of the NIHR to gather and synthesise stakeholder views on the future of health and healthcare in England in 20 to 30 years' time. The aim of the research was to generate an evidenced-based picture of what future needs in England may be and how they might differ from today, in order to inform strategic discussions about the future priorities of the NIHR and the health and social care research communities more broadly.
Response
The survey provided a rich and varied dataset based on responses from 299 stakeholders in total. Over half (153/299) answered in their capacity as a "professional representative" of their organisation and 146 in their capacity as a "private individual." A wide range of fields were represented, including, but not limited to, public health, social care, primary care, cancer, genomics, mental health, geriatrics, child health, patient advocacy and health policy. The respondent group also included a number of professional and private stakeholder categories, such as clinicians, policy experts, academics and patient and public representatives.
Findings
A summary of the key themes which emerged from survey responses is presented below in Table 1. Respondent views on the future differences and trends shaping the future health landscape were thematically grouped into three overarching areas: population health, health systems and performance, and perceived priorities for supporting research and impact. Themes cover stakeholders' expectations of the trends and changes likely to shape the future health and healthcare landscape in England, as well as their views on associated priorities for research and the research infrastructure in responding to this predicted future.
Table 1. Summarised Trends and Research Focus Areas Raised in Survey Responses
Key Trends
Key Areas for Future Research Investment
Population health
The challenge of an ageing population
Lifestyle and environmental drivers of disease: public health and prevention
The challenge of increasing health inequalities
Trends in mental health
Global challenges and changing patterns of disease
Addressing the challenge of an ageing population and associated multi-morbidities
Improving strategies for public health and prevention
Understanding and tackling health inequalities and their determinants
Exploring the causes and effects of mental ill health
Improving maternal and child health for a life-course approach
Responding to the threat of anti-microbial resistance and infectious disease
Evidence gaps in specific disease areas
Health systems and performance
Transformations in the organisation and delivery of health and social care
Focus on interventions for public health and prevention
Advances in technology and medical science
Access to and availability of new kinds of patient and public data
Understanding and implementing effective health and social care
Ensuring the safe, effective and equitable implementation of advances in technology and medical science
Perceived Priorities for Supporting Health Research and Impact
Developing new processes and structures for research governance and administration
Embedding research in the NHS
Driving new approaches to research
Facilitating patient and public involvement in research
Respondent views on the future differences and trends shaping the future health landscape emphasised a range of themes relating both to population health and to health systems and performance. Particularly pertinent examples that emerged included: an ageing population, living longer but not necessarily in better health; rising health inequalities and the increasing influence of unhealthy lifestyle choices; increases in the burden of mental health, especially for children and older people; and the future threat of changing patterns of infectious and respiratory disease, in part due to anti-microbial resistance (AMR) and air pollution.
Transformations in health and social care were anticipated to interact with these trends in a number of ways. Changes in models of care to tackle the health challenges associated with an ageing population and increasingly complex physical and mental illness included shifts towards more holistic, integrated models of care and prevention, supported by more multi-disciplinary working amongst health and social care professionals. Advances and expansion in the use of technology, such as artificial intelligence (AI) and digital apps, were expected to facilitate the roll-out of self-management approaches for patients, but concerns were expressed that due to differential access across groups, such approaches risked exacerbating inequalities in health. Advances in genomics and personalised medicine were seen as holding transformative potential for prevention, diagnostics and treatment; however, respondent views varied on the degree to which personalised approaches could be widely implemented in the NHS in the near future. Access to and availability of data was another key area of predicted change, as researcher and clinician access to vast population-level datasets ("big data") and linked service datasets could inform approaches to prevention, diagnostics and treatment with previously inaccessible insights into public behaviours, service use and health status. However, barriers to maximising these benefits included currently unresolved ethical and data quality issues.
Priorities for research raised by respondents resonate with the key predicted challenges for health and social care and highlight the need for enhanced understanding of the drivers and effects of trends affecting health and care, as well as of effective interventions and strategies to tackle and mitigate these challenges. Key areas deemed to warrant further research included managing and understanding multi-morbidity, addressing social determinants of health inequalities, understanding the causes and effects of mental illness, and responding to the threat of infectious disease pandemics. Respondents also highlighted the importance of research into improving approaches to care and support for older people, women and children, informal carers and those at the end of life, and into improving the equitable and effective uptake and spread of health innovations in the NHS, including advances in technology, genomics and research more broadly.
Finally, in order to provide a supportive environment for health research and impact, respondents saw a key role for health funders and coordinating bodies in overseeing and investing in programmes which underpin quality research nationally. Key priorities included: ensuring the responsiveness of research governance and ethics reviews to a changing research landscape, in particular in terms of access to linked datasets; continuing to build on research capacity building and facilitating proven approaches to research translation into order to embed the use and conduct of research in the NHS; facilitating the use of appropriate methodologies and the latest technologies in the design and conduct of health research; and continuing to strengthen representative patient and public engagement in health research at all stages.
Conclusions
By providing overarching insights into the synthesised views and perceived priorities of a wide range of multi-disciplinary health and social care stakeholders, this research offers a unique contribution to the existing literature on the future of health in England and in the UK more widely. The study findings validate a number of prominent health research priorities currently visible in England, such as AMR, the burden of dementia and age-related multi-morbidity, digital health and genomics. Interest in and prioritisation of these and other themes, such as mental health, health inequalities and transforming health service models, cut across disciplinary boundaries. However, it is clear that there is divergence in views among stakeholders on the relative importance of these areas of focus, and on the best approach to managing their emergence in the coming decades. Tensions were visible, for example, between desires for future investment and emphasis on expensive, cutting-edge treatments and technologies in specialist care on one hand, and the perceived necessity of shifting emphasis away from the biomedical model to low-cost prevention, public health and community-based solutions on the other. It will be important for the health research community, its funders and its coordinating bodies to leverage this diversity of views in strategic discussions going forward to ensure that it benefits from the challenge and innovation offered by the dissenting, varied and minority viewpoints that exist.
The health challenges of the coming decades may look significantly different to those faced today. Demographic changes, technological advances, and socioeconomic and environmental developments, to name a few, are expected to shape—and in some cases transform—the future health and social care landscape.
This article presents findings from a survey conducted by RAND Europe at the request of the NIHR to gather and synthesise stakeholder views on the future of health and healthcare in England in 20 to 30 years' time. The aim of the research was to generate an evidenced-based picture of what future needs in England may be and how they might differ from today, in order to inform strategic discussions about the future priorities of the NIHR and the health and social care research communities more broadly.
Response
The survey provided a rich and varied dataset based on responses from 299 stakeholders in total. Over half (153/299) answered in their capacity as a "professional representative" of their organisation and 146 in their capacity as a "private individual." A wide range of fields were represented, including, but not limited to, public health, social care, primary care, cancer, genomics, mental health, geriatrics, child health, patient advocacy and health policy. The respondent group also included a number of professional and private stakeholder categories, such as clinicians, policy experts, academics and patient and public representatives.
Findings
A summary of the key themes which emerged from survey responses is presented below in Table 1. Respondent views on the future differences and trends shaping the future health landscape were thematically grouped into three overarching areas: population health, health systems and performance, and perceived priorities for supporting research and impact. Themes cover stakeholders' expectations of the trends and changes likely to shape the future health and healthcare landscape in England, as well as their views on associated priorities for research and the research infrastructure in responding to this predicted future.
Table 1. Summarised Trends and Research Focus Areas Raised in Survey Responses
Key Trends
Key Areas for Future Research Investment
Population health
The challenge of an ageing population
Lifestyle and environmental drivers of disease: public health and prevention
The challenge of increasing health inequalities
Trends in mental health
Global challenges and changing patterns of disease
Addressing the challenge of an ageing population and associated multi-morbidities
Improving strategies for public health and prevention
Understanding and tackling health inequalities and their determinants
Exploring the causes and effects of mental ill health
Improving maternal and child health for a life-course approach
Responding to the threat of anti-microbial resistance and infectious disease
Evidence gaps in specific disease areas
Health systems and performance
Transformations in the organisation and delivery of health and social care
Focus on interventions for public health and prevention
Advances in technology and medical science
Access to and availability of new kinds of patient and public data
Understanding and implementing effective health and social care
Ensuring the safe, effective and equitable implementation of advances in technology and medical science
Perceived Priorities for Supporting Health Research and Impact
Developing new processes and structures for research governance and administration
Embedding research in the NHS
Driving new approaches to research
Facilitating patient and public involvement in research
Respondent views on the future differences and trends shaping the future health landscape emphasised a range of themes relating both to population health and to health systems and performance. Particularly pertinent examples that emerged included: an ageing population, living longer but not necessarily in better health; rising health inequalities and the increasing influence of unhealthy lifestyle choices; increases in the burden of mental health, especially for children and older people; and the future threat of changing patterns of infectious and respiratory disease, in part due to anti-microbial resistance (AMR) and air pollution.
Transformations in health and social care were anticipated to interact with these trends in a number of ways. Changes in models of care to tackle the health challenges associated with an ageing population and increasingly complex physical and mental illness included shifts towards more holistic, integrated models of care and prevention, supported by more multi-disciplinary working amongst health and social care professionals. Advances and expansion in the use of technology, such as artificial intelligence (AI) and digital apps, were expected to facilitate the roll-out of self-management approaches for patients, but concerns were expressed that due to differential access across groups, such approaches risked exacerbating inequalities in health. Advances in genomics and personalised medicine were seen as holding transformative potential for prevention, diagnostics and treatment; however, respondent views varied on the degree to which personalised approaches could be widely implemented in the NHS in the near future. Access to and availability of data was another key area of predicted change, as researcher and clinician access to vast population-level datasets ("big data") and linked service datasets could inform approaches to prevention, diagnostics and treatment with previously inaccessible insights into public behaviours, service use and health status. However, barriers to maximising these benefits included currently unresolved ethical and data quality issues.
Priorities for research raised by respondents resonate with the key predicted challenges for health and social care and highlight the need for enhanced understanding of the drivers and effects of trends affecting health and care, as well as of effective interventions and strategies to tackle and mitigate these challenges. Key areas deemed to warrant further research included managing and understanding multi-morbidity, addressing social determinants of health inequalities, understanding the causes and effects of mental illness, and responding to the threat of infectious disease pandemics. Respondents also highlighted the importance of research into improving approaches to care and support for older people, women and children, informal carers and those at the end of life, and into improving the equitable and effective uptake and spread of health innovations in the NHS, including advances in technology, genomics and research more broadly.
Finally, in order to provide a supportive environment for health research and impact, respondents saw a key role for health funders and coordinating bodies in overseeing and investing in programmes which underpin quality research nationally. Key priorities included: ensuring the responsiveness of research governance and ethics reviews to a changing research landscape, in particular in terms of access to linked datasets; continuing to build on research capacity building and facilitating proven approaches to research translation into order to embed the use and conduct of research in the NHS; facilitating the use of appropriate methodologies and the latest technologies in the design and conduct of health research; and continuing to strengthen representative patient and public engagement in health research at all stages.
Conclusions
By providing overarching insights into the synthesised views and perceived priorities of a wide range of multi-disciplinary health and social care stakeholders, this research offers a unique contribution to the existing literature on the future of health in England and in the UK more widely. The study findings validate a number of prominent health research priorities currently visible in England, such as AMR, the burden of dementia and age-related multi-morbidity, digital health and genomics. Interest in and prioritisation of these and other themes, such as mental health, health inequalities and transforming health service models, cut across disciplinary boundaries. However, it is clear that there is divergence in views among stakeholders on the relative importance of these areas of focus, and on the best approach to managing their emergence in the coming decades. Tensions were visible, for example, between desires for future investment and emphasis on expensive, cutting-edge treatments and technologies in specialist care on one hand, and the perceived necessity of shifting emphasis away from the biomedical model to low-cost prevention, public health and community-based solutions on the other. It will be important for the health research community, its funders and its coordinating bodies to leverage this diversity of views in strategic discussions going forward to ensure that it benefits from the challenge and innovation offered by the dissenting, varied and minority viewpoints that exist.
The research described in this article was commissioned by the National Institute for Health Research (NIHR) and conducted by RAND Europe.
